HERNIA 
-€lves from being coftive, for reafons too obvious to need 
relating. By thefe means, and with thefe cautions, many 
people have paffed their lives for many years free from difeafe 
or complaint with very large irreducible ruptures. 
“On the other hand, it is fit that mankind fhould be ap- 
_ prifed, that the quiet inoffenfive ftate of this kind of hernia 
is by no means to be depended upon; many things may 
-on a new portion which may at any time be added to it, are 
hernia, is in one refpeét greater than that attending one that 
has been found at times reducible; fince, from the nature of 
the cafe, it will hardly admit of any attempt toward relief, 
but the operation, and that in thefe circumftances mutt ne- 
ceflarily be accompanied with additional difficulty. 
** Among the ruptures which have been thought not redu- 
cible, and. treated as fuch, there have been fome which, 
upon more judicious and more patient attempts, have been 
capable of reduction. 
render them capable of pafling back again into the belly.’’ 
Pott on Ruptures. 
_Fabricius Hildanus gives an account of a man who was 
radically cured of a rupture, of twenty years’ date, by fix 
months’ confinement to bed. ent. 5. Obf. 
Le Dran and Arnaud relate inftances of monftrous bubo- 
noceles, which difappeared entirely after the patients had 
n long confined to bed, and become much emaciated 
by tedious illneffes. Some of the moderns have imitated 
this operation of nature, and by frequent bleedings and re- 
peated purges, have fometimes fo far reduced the fre of the 
hernia, that it has been returned into the abdomen. 
Hey has feveral times fucceeded in this way, (p. 219.) But 
this practice cannot prove fuccefsful, when the vifcera ad- 
here to the fac, or to the peritoneum, juft within the abdo- 
- The greateft objection to this method of cure is the 
want of an abfolute criterion, by which to diftinguifh when 
the parts do or do not adhere to the hernial fac, and, in 
“ 
advanced years, though one were fure that the vifcera were d 
free 
from the fac, the poffibility of hurting the body by the 
neceflary evacuations is allo another objeétion. Sharp’s 
Critical Enquiry, p. 15. 
Were the plan to be thought worthy of trial, keeping 
up a conftant preffure on the tumour by means of a fufpen- 
to its ea a contraction of the fcrotum, which per- 
he office of a flrong and permanent compreffion of 
the tumour, “ ao 
any attempts of this kind fucceed, “ a trufs 
fhould be immediately put on, and worn conftantly without 
. remiffion ; for in thefe people the largenefs of the abdominal 
aperture, the thickuefs of the hernial f ac, and the relaxation 
_ of the mefentery, make a new defcent always to be appre- 
- beaded and guarded again.” Pott, 
There are inftances, however, on record, in’ which’ the 
capacity of the abdomen had become fo adapted to the di. 
minifhed quantity of the vifcera, that when the contents of 
the hernia were reduced, ferious complaints arofe from their 
introduGion into the belly, Schmucker has met with fe. 
veral fuch cafes, in which he has been obliged to take off 
the trufs. Petit has known the reduétion of a hernia of 
this kind prove fatal, the parts not defcending again when 
the trufs was removed, the naufea and vomiting which arofe 
continuing, and peritonitis taking place. Chirurgifche, 
Wahrnehmungen, vol. ii. p. 243. ‘Traité des Maladies Chi- 
rurgicales, tom. ii. p. : 
r. Pott remarks, that * an omental rupture, which has 
texture, or fo connected as to be incapable of reduétion, may 
by accident inflame, and either become gangrenous or 
{uppurate, and the occafion of a great deal of trouble,” 
n a few inilances, epiploceles produce very bad fymptoms 
indeed, cafes of which are to be found in Garengeot, Dio- 
nis, &c. z 
its being particularly attended to, left a {mall piece of gut 
flip down, and, being preffed on by the trufs, produce fatal 
mifchief, . LZ 
Herniz are fometimes, though not very often, rendered 
- irreducible by a contraétion of the fac. Mr. Aftley Cooper 
has feen fuch a contraétion happen at the middle of the fac, 
fo as to occafion an hour-glafs appearance, a piece of omen- 
tum lodging beth above and below the conftriétion. ; 
The omentum, in old irreducible herniz, occafionally be- 
8 
comes affeGted with fuch hardnefs as is called {chirrus, though 
uction, but the protruded vifcera fuffer in the paflage 
Qa 
- FI ts of 
eructations and a foon come on. The contents © 
the ftomach are firft difc 
motion has begun in the bowels, bilious matter is thrown Up: 
is certain that he has feen feculent matter evacuated by ve 
the fre- 
quently imperfect itate of the valve of the cecum, = 
its action being reverfed by the antiperiftaltic ene if 
of the inteitines. An obftinate conftipation attends fe 
: : . ‘ fters. 
portion of inteftine below the ftrangulation by glyiters- 
The obftruétion to the paffage of the intel inal ere she 
may not be. fo clearly marked, where a part on iil often 
diameter of the inteftine is flrangulated ; but 1 will be 
occur to as great a = in this circumflance, equally 
